Kforce HMO Claims Follow Up Representative in Sacramento, California

Kforce has a client seeking a HMO Claims Follow Up Representative in Sacramento, California (CA).Responsibilities:

  • Performs all billing and follow-up functions, including the investigation of payment delays resulting from pended claims, with the objective of receiving appropriate reimbursement based upon services delivered and ensuring that the claim is paid/settled in the timeliest manner possible

  • Applies knowledge of specific payer billing/payment rules, managed care contracts, reimbursement schedules, eligible provider information and other available data and resources to research payment variances, make corrections, and take appropriate corrective actions to ensure timely claim resolutions

  • Submits 3rd party claims and patient statements including the maintenance of bill holds and the correction of errors, to provide timely, accurate billing services

  • Edits technical (UB-04) claim forms within the patient accounting system and external Claims Scrubber, using proper data element instructions for each payer, applying principles of coordination of benefits, and ensuring that correct diagnosis, and procedure codes are utilized

  • Researches claim rejections, making corrections, taking corrective actions and/or referring claims to appropriate staff members for follow through to ensure timely claim resolutions

  • Conducts account follow up including the investigation of payment delays resulting from pending claims, with the objective of appropriately maximizing reimbursement based upon services delivered and ensuring claims are paid and settled in the timeliest manner

  • Responds to customer service tier 3 patient and 3rd party payer inquiries (telephone, fax, mail and web-based patient portal), complaints or issues regarding patient billing and collections, either responding directly or referring the problem to an appropriate

  • High School diploma or GED/equivalent required

  • AA/AS or equivalent experience and education is desired

  • Certified Healthcare Access Associate (CHAA) and/or Certified Patient Account Technician (CPAT) and/or Certified Revenue Cycle Representative (CRCR)

  • Experience within a hospital or clinic environment, an insurance company, managed care organization or other financial service setting, performing financial counseling, financial clearance and/or customer service activities as typically acquired in two years

  • Completion of regulatory/mandatory certifications and skills validation competencies preferred

Kforce is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, or disability status.Compensation Type:Hours